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It's important for us to get recognized and be somebody: Community health worker attributes, attitudes towards certification, and certification options in California


Community health workers (CHWs) are trusted members of the community who have an intimate understanding of the populations and communities they serve. They deliver culturally informed interventions to their communities and leverage their shared experiences and linguistic and cultural relationships to bridge their community to health care and social services. Historically successful in developing countries, CHWs promote chronic disease management, improve health outcomes, and reduce health care costs.

Despite the evidence, CHWs are not widely utilized within the health care system. The National Academy of Medicine declares barriers to working with CHWs, such as inconsistent scope of practice, variable training and qualifications, and lack of professional recognition by other health care providers. States are investigating ways to standardize the CHW workforce, such as certification, to set workforce entry standards and integrate CHWs into health care systems.

Currently, the CHW workforce faces a crossroads. One path leads to a standardized CHW workforce integrated into health care systems via formalized training and qualifications. The other path holds CHWs as part of the communities where they live and work, valuing their relationships and embodied knowledge. While both paths are options for the CHW workforce, CHWs and CHW stakeholders must determine if or how these two paths can coexist. California is the perfect case study because there is continued debate across CHW stakeholders about the stakes of certifying CHWs. California’s diverse CHW workforce represents varying CHW types with contrasting ideologies of care, such as clinical and community-based CHWs and promotores de salud, a subset of CHWs who primarily serve Latinx communities and are grounded in a social, rather than medical, model of care. California’s size and social characteristics pose implementation factors that are relevant for the diverse issues other states will have to address for their own CHW workforce.

This dissertation identifies the unique contributions offered by CHWs to fill health system gaps and challenges differently than other health care providers. The research then describes feelings of opportunity and exclusion related to CHW certification in California. Finally, this dissertation presents strategic options for California stakeholders to develop an appropriate CHW certification model.

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